Why this junior doctor won’t be on strike today

The BMA would do well to remember that the Government has a right to demand
health reforms

Junior doctors on a protest march in London in OctoberPhoto: PA

By Alexander Suebsaeng

7:00AM GMT 12 Jan 2016

I am a junior doctor and recently finished seven 12-hour days on call. It was a week of physical, mental and emotional exhaustion, including two situations of the sort of visceral horror that most people encounter only once or twice in a lifetime.

I am keenly aware that many colleagues had a far worse week, so I blush to describe mine; but I do think it sheds light on the psychology of the junior doctors’ strike. We are overworked in a difficult job. We are slightly underpaid. And we are very stressed by a system that always feels dangerously overstretched. The intensity of this experience unifies us – all the more so because others can never properly understand it.

So politicians have to tread carefully to avoid causing deep offence. Any attack – real or perceived – makes us close ranks. That is why the vote for industrial action in November was carried so overwhelmingly.

But I did not vote to strike, and will not be doing so today. Everyone knows what it could mean for patients.

The BMA has published a summary of the recent negotiations, according to which four significant areas of disagreement remain. Three concern pay, in particular the definition of antisocial hours. The other is about safeguarding measures to ensure adherence to the new hours policy. Is this latter really irresolvable? Or is it just there to anticipate the charge that this is all about money?

The Government has promised that there will be no pay cut for all but one per cent of junior doctors. Some will even see a pay rise. True, many will not get the rise they expected. But that is very different from a cut. And if that is what we are striking about, we need to be upfront about it with a public that has voted to accept austerity.

We have also been assured that the maximum hours we can be required to work will be reduced. Some of us may work longer hours but many will work fewer. And the longest shifts will go. They may not be such congenial hours – there will certainly be more weekends. But those are the same hours that plenty of other professions accept, including nurses.

"If you’re threatening to leave the country because of a better deal elsewhere, you can’t also play the martyr to the cause of free healthcare"

The Government has its own plan for a safer NHS that involves spreading weekday cover thinner to cover weekends better. Doctors might think this undesirable. That happens to be my view. But it is not unworkable. And the Government does have a democratic mandate to attempt this. Of course, doctors have a right – even a duty – to challenge that plan. But they need to do so constructively, not by walking out of talks.

Unfortunately, doctors and especially the BMA have become intransigent. In recent months we have inflamed grievances with misinformation and anti-Government rhetoric on social media. The debate has become emotive and ideological.

But we would do well to count our blessings. When lamenting how little we earn, we might remember that taxpayers have subsidised our medical education. We all leave with debts, but they are a fraction of what they would be elsewhere. Nor are we bound to stay here, repaying the Government with our labour. Indeed, it has been threatened that Jeremy Hunt’s reforms will drive Britain’s doctors to Australia, where a massive private sector makes for better pay and conditions.

But there is a problem with this threat. Junior doctors have identified their own cause with that of the NHS as a whole. Hunt’s reforms have been challenged as an attack not only on doctors but on the institution. Many doctors even claim that there is a deliberate plot to vitiate the NHS so completely that arguments for its privatisation become irresistable.

This is all very well. But if you’re threatening to leave the country because of a better deal elsewhere, you can’t also play the martyr to the cause of free healthcare.

We doctors have a unique perspective on the NHS that should be taken into account in any effort at reform. But ours is not the only view, nor the most important. Ultimately we must accept political leadership even when we disagree with it – that is the whole point of a nationalised health service. It will often be a bitter pill to swallow – it was in 1948.

But then it’s an oft-forgotten founding principle of the NHS: doctor doesn’t always know best.